Healthcare Provider Details

I. General information

NPI: 1982857686
Provider Name (Legal Business Name): SUNRISE THERAPY & SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 LINDEN AVE SUITE 109
OXFORD NC
27565-3683
US

IV. Provider business mailing address

PO BOX 3265
HENDERSON NC
27536-6265
US

V. Phone/Fax

Practice location:
  • Phone: 252-915-0122
  • Fax: 919-529-2096
Mailing address:
  • Phone: 252-915-0122
  • Fax: 919-529-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICE MARIE WILLIAMS
Title or Position: OWNER
Credential:
Phone: 252-915-0122